I Am 5'5 with a Size 42h/i Breasts.do You Think I Will Get Approved for Br Surgery? i am overweight but am constantly trying to lose it (no thanks to deprovera birth control shot).i have united health care insurance and was denied by them in all three stages. im confused as to why. every doctor i've com into contact with has said this surgery needs to happen. i have receipts for a new bed i had to purchase, bras, gym memberships, personal trainers, photos, etc. i dont understand why im still getting told no. and is there special funding?
Doctors Say I Need a Breast Reduction For My Health, But My Insurance Keeps Saying No. What Can I Do?
Doctor Answers (6)
Doctors Say I Need a Breast Reduction For My Health, But My Insurance Keeps Saying No.
Are you relying on your insurance company to make your health care decisions? If so, you will receive very little care. Their only interest in your health is to determine how little they can pay and still meet their contractual obligations. They set limits and you have to meet them or they don't have to pay. If you need a reduction, get one and pay for it. It will be one of the best things you will ever do for yourself. At least 1/3 of my reduction patients pay for their surgery because their insurance company sets the bar too high for many patients to receive insurance coverage.
More insurance companies are not including breast reduction as a covered procedure.
Whether a breast reduction should be covered by insurance is a philosophical issue. Patients are helped functionally most of the time but, on the other hand, it is an operation that can be budgeted for and is certainly not an emergency. Furthermore, deductibles will continue to get so high that patients will have to pay cash as a matter of practicality.
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Thank you for the question.
Based on your description you may be an excellent candidate for breast reduction surgery; it is one of the most patient pleasing operations would perform. Also, you may benefit from professional assistance from physicians, personal trainers and/or nutritionists to help you with your weight loss program.
It may be that with ongoing weight loss your insurance company will authorize the procedure. Unfortunately, it can be quite difficult to obtain this authorization (as you have found out). Sometimes appealing the health insurance (with the help of your plastic surgeon) may be effective.
If these measures do not work, then working with well experienced board-certified plastic surgeons' offices to help you with financing may be your only/best option.
Breast Reduction - My Insurance Keeps Saying No
Each insurance company has its own criteria as to what they will consider a "covered" procedure but with a 42H/I bra size, my guess is that they feel you are too heavy for your frame and they would like to see you lose weight first. Or, at least, that you've failed several attempts at conservative therapy (weight loss, chiropractic care, etc). I would suggest that you meet with your plastic surgeon and try to work out some sort of a plan that addresses all of these issues. In general, the surgery is more likely to be "covered" if you can indicate that specific symptoms, such as neck, back and shoulder pain, bra strap grooving, and intertrigo, would be relieved by the surgery. Hopefully you will then be able to get approval.
I hope that this helps, and good luck,
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.